Differentiated service delivery for HIV treatment models in Thailand: A cross-sectional assessment of real-world implementation and uptake.

OBJECTIVES: First, to describe the antiretroviral therapy (ART) delivery models available in Thailand to understand differentiated service delivery for further service system optimization and expansion of best practices; second, to determine the client characteristics associated with model uptake. METHODS: Across-sectional assessment using secondary data was conducted to describe ART models implemented as routine services at four public hospitals in three major provinces with a high-HIV burden in Thailand. From April to October 2020, ART clients were screened consecutively according to the inclusion criteria: Thai, aged ≥18 years, and on ART for ≥6 months. HIV treatment models were categorised based on the service type, location, provider, and frequency. Logistic regression was used to identify the associated factors. RESULTS: Seven individual ART delivery models were identified: four were facility-based and three were out-of-facility. No group models were identified. Of 3,366 records of ART clients reviewed, 3,213 (95.5%) met the study criteria and received ART through the following models: conventional (32.6%), nurse-led clinical consultation (10.0%), fast-track refill (29.0%), after-hours clinic (10.6%), pharmacist-led pickup center (3.6%), key population-led community-based organisation (2.7%), and mailing (11.5%). Age, population, duration on ART, and viral load were associated with the uptake of certain alternative service models when compared to the conventional model. CONCLUSIONS: Among the variety of ART delivery approaches available in Thailand, facility-based models remain the most prevalent. Future work should investigate the role of client preference and choice in choosing service models and service utilisation patterns over time, and assess the acceptability and effectiveness of these models.

Occurrence of mcr-mediated colistin resistance in Salmonella clinical isolates in Thailand.

Nontyphoidal Salmonella, an important zoonotic pathogen and a major cause of foodborne illnesses, could be a potential reservoir of plasmids harbouring mobile colistin resistance gene (mcr). This study reported, for the first time, a high rate of mcr-carrying Salmonella clinical isolates (3.3%, 24/724) in Thailand, associated with mcr-3 gene (3.0%, 22/724) in S. 4,[5],12:i:-(15.4%, 4/26), S. Typhimurium (8.8%, 5/57), and S. Choleraesuis (5.6%, 13/231). Remarkably, the increasing trends of colistin and extended-spectrum cephalosporin resistances have displayed a high agreement over the years, with a dramatic rise in the mcr-carrying Salmonella from 1.1% (6/563) during 2005-2007 to 11.2% (18/161) during 2014-2018 when CTX-M-55 became abundant. Clonal and plasmid analysis revealed that the self-transferable IncA/C and a novel hybrid IncA/C-FIIs MDR plasmids were the major vehicles to disseminate both mcr-3 and blaCTX-M55 genes among diverse Salmonella strains, from as early as 2007. To our knowledge the occurrence of mcr-3 and the co-existence of it with blaCTX-M-55 in S. Choleraesuis are reported here for the first time, leading to clinical concern over the treatment of the invasive salmonellosis. This study provides evidence of the potential reservoirs and vectors in the dissemination of the mcr and highlights the co-selection by colistin and/or cephalosporins.

A comparative study to determine the recovery rate of microorganisms of bloodstream infections: two versus three blood culture specimens.

OBJECTIVE: There has been a development of automated and continuous-monitoring blood culture systems that are more sensitive than conventional systems for the detection of microorganisms. Whether two or three blood culture specimens obtained during a 24-hour period using these automated systems achieving a higher recovery rate of microorganism remains to be determined. The present study was aimed to compare the recovery rates of microorganism of blood-stream infections (BSIs) using two and three blood culture specimens. MATERIAL AND METHOD: A prospective investigator-blinded study was carried out in patients who needed to have blood cultures in medicine wards and intensive care units as well as an emergency room of King Chulalongkorn Memorial Hospital, Bangkok, Thailand, between October 1, 2010 and March 31, 2011. Three blood culture specimens were obtained from each patient during a 24-hour period. Each specimen was inoculated into an aerobic bottle of blood culture broth (TREK Diagnostics, Cleveland, OH, US), and then incubated at 37 degrees C for seven days. RESULTS: Of 568 patients, there were 116 (20.4%) unimicrobial episodes with three blood cultures obtained during a 24-hour period. There were 70 (12.3%) and 46 (8.1%) episodes of true pathogen and contaminant, respectively. The recovery rates of true pathogen were 75.7% (53 isolates), 87.1% (61 isolates), and 100% (70 isolates) with the first, second, and third blood culture specimens, respectively (p < 0.05 between the recovery rate with the first two and the third blood culture specimens). There were 25 (35.7%), 38 (58.6%) isolates, and four (5.7%) of Gram-positive, Gram-negative bacteria, and fungi, respectively. Among 25 Gram-positive bacteria, Staphylococcus aureus was the most common isolate (10, 14.3%), followed by Streptococcus pneumoniae (5, 7.1%) and Enterococcus faecalis, Enterococcus faecium, coagulase-negative Staphylococcus (3, 10% each). Among 38 Gram-negative bacteria, Escherichia coli was the most common isolate (13, 18. 6%), followed by Pseudomonas aeruginosa (8, 11.4%), and Klebsiella pneumoniae (6, 8.6%). The sensitivity and specificity of the recovery rate of microorganisms using two blood culture specimens were 85.7% and 92.3%, respectively. The sensitivity and specificity of the recovery rate of microorganisms using three blood culture specimens were 100% and 90.8%, respectively. CONCLUSION: To the best of the authors'knowledge, the present study is the first prospective study to compare the recovery rate of microorganisms of BSIs between the two and three blood culture specimens using the VersaTREK blood culture system. Three blood culture specimens are required to achieve the recovery rate of more than 99%.